Health care report cards publicly report information about physician,
hospital, and health plan quality in an attempt to improve that quality. Reporting
quality information publicly is presumed to motivate quality improvement through
2 main mechanisms. First, public quality information allows patients, referring
physicians, and health care purchasers to preferentially select high-quality
physicians. Second, public report cards may motivate physicians to compete
on quality and, by providing feedback and by identifying areas for quality
improvement initiatives, help physicians to do so. Despite these plausible
mechanisms of quality improvement, the value of publicly reporting quality
information is largely undemonstrated and public reporting may have unintended
and negative consequences on health care. These unintended consequences include
causing physicians to avoid sick patients in an attempt to improve their quality
ranking, encouraging physicians to achieve “target rates” for
health care interventions even when it may be inappropriate among some patients,
and discounting patient preferences and clinical judgment. Public reporting
of quality information promotes a spirit of openness that may be valuable
for enhancing trust of the health professions, but its ability to improve
health remains undemonstrated, and public reporting may inadvertently reduce,
rather than improve, quality. Given these limitations, it may be necessary
to reassess the role of public quality reporting in quality improvement.

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